All elective surgeries at Mission Hospital, the third-largest hospital in Orange County, are on hold after four patients who underwent orthopedic operations developed infections.

The hospital opted to close its 14 operating rooms in Mission Viejo and Laguna Beach last week after a major accrediting agency, The Joint Commission, intervened and found, among other problems, high temperatures and humidity in some of the rooms, according to Chief Medical Officer Dr. Linda Sieglen.

The Joint Commission – which certifies agencies for Medicare and Medicaid funding – issued a preliminary decision Oct. 8 to deny Mission Hospital its accreditation. The hospital has 23 days to come into compliance with federal standards.

“Hospitals take it very seriously when this happens,” The Joint Commission spokeswoman Elizabeth Eaken Zhani said.

Ultimately, if its accreditation is revoked, Mission Hospital could lose its Medicare and Medicaid funding. Medicare funding accounted for 20.9 percent of Mission’s inpatient reimbursement in 2011, according to a state database.

Fewer than 1 percent of hospitals nationwide are actually denied accreditation each year, according to The Joint Commission.

“We’re certainly not near there yet,” Sieglen said. “That would be up to The Joint Commission. I know they’re very pleased with our action plan so far.”

Mission Hospital is the only hospital in California with the preliminary denial designation right now, according to The Joint Commission’s online database. With the exception of St. Joseph Hospital in Orange, the other large hospitals in the county are in good standing.

In June, The Joint Commission gave St. Joseph an “accreditation with follow-up survey” status after finding it was not compliant with dozens of federal standards, including those related to infections, accurate and complete medical records and medication labels. That status gives St. Joseph 30 days to six months to fix its problems.

The Joint Commission issues a preliminary denial when there is an immediate threat to the health or safety of patients, a “significant non-compliance” with standards or a failure to resolve an “accreditation with follow-up survey” status after two opportunities. Sieglen said The Joint Commission’s action against Mission Hospital was more severe because it stemmed from a complaint over the four infections from someone who works at the hospital.

Through good hygiene and technique, infections are largely preventable – between 55 percent and 70 percent of cases, depending on the type of infection, according to a University of Pennsylvania, Philadelphia study. Still, infections remain among the leading causes of death nationwide, according to the Centers for Disease Control and Prevention.

They are also among the most common complications of hospital care, according to the California Department of Public Health, occurring when bacteria, fungi and viruses land on medical equipment, surfaces and patients.

In the case of the four patients at Mission Hospital, who became sick after undergoing surgeries in late May and early June, the infections were what are called “surgical site infections,” meaning germs got into the area where the operation was performed. Citing patient confidentiality, Sieglen would not disclose more precisely the types of surgeries involved.

The infections were not serious, and the patients recovered after they were treated with antibiotics, Sieglen said.

The hospital closed one operating room followingthose infections, and tried to determine what might have caused them by culturing equipment and evaluating its process for sanitizing trays, for example. Sieglen said hospital staffers “took lots of steps at that time” to evaluate the cause but could not come up with a source.

“We found no evidence of infection on our equipment, so the bottom line is: Our equipment was not infected,” she said.

That hospital plans to install new heating and air conditioning equipment, and to adopt new procedures that would improve hospital documentation and staff communication.

More than 7,000 surgeries are performed annually at Mission Hospital, and about 70 percent of those are elective, according to Sieglen.

Emergency procedures are still being performed in the operating rooms. “We do not feel like there is a risk to patients,” Sieglen said.

It is up to surgeons and others to decide when a patient needs an emergency surgery, she said. Generally, if the surgery does not need to be done in the next 24 hours, it is not considered an emergency, she said.

The CDC tracks and compares infection data reported by hospitals. For all the infections from October 2012 to September 2013 for which data are available, Mission Hospital scored no different than the national benchmark. And in The Joint Commission’s last full survey in 2012, Mission Hospital met all the national patient safety goals related to lowering the risk of infections.

Sieglen said the operating rooms will remain closed “just until we have a good comfort level – we do believe we will be open soon. It’s never a bad thing to be overly cautious.”

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